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PubMed1983

[Antibacterial activity of apalcillin against 300 strains of enterobacteria].

The in vitro bacteriostatic activity of apalcillin was compared with those of piperacillin, mezlocillin and carbenicillin. The minimal inhibitory concentrations determined by a microtiter dilution method, show a bi-modal distribution: apalcillin, piperacillin: 1 mg/l - greater than 128 mg/l; mezlocillin: 2 mg/l - greater than 128 mg/l; carbenicillin: 4 mg/l - greater than 128 mg/l. Two thirds of the isolates are inhibited by 8 mg/l of any antibiotic, except carbenicillin (128 g/l). Two genus seem less susceptible: Klebsiella display modal MIC of apalcillin and piperacillin equal to 4 mg/l and above 128 mg/l: Serratia isolates resist to 128 mg/l, whatever antibiotic is considered. The in vitro bactericidal activity of apalcillin was evaluated by killing-curves method against 8 Enterobacteriaceae strains. Used at a concentration equal to the MIC or twice the MIC, apalcillin produces a 1,5-2 log10 reduction in viable count, 3 hours after the addition of antibiotic.

Ampicillin↗
PubMed1983

[Effect of multiresistance on the minimal inhibitory concentration of N-formimidoyl thienamycin and 6 comparing substances against P. aeruginosa and 4 Enterobacteriaceae species].

The minimal inhibitory concentrations (MICs) of multiresistant strains of P. aeruginosa and four species of Enterobacteriaceae were compared with those of more sensitive ones in N-f-thienamycin and six other antibiotics. The greatest difference between these two differently resistant bacterial populations was found in cefoperazone and the beta-lactamase-instable piperacillin. The latter was used for comparison purposes. The activity of cefsulodin was distinctly reduced in multiresistant strains of P. aeruginosa. Cefotaxime and lamoxactam displayed slightly elevated MICs in multiresistant strains. In N-f-thienamycin a significant difference between the multiresistant and the more sensitive population could not be verified (p greater than 0.05). In this regard it resembles fosfomycin. beta-lactam antibiotics could be ranked by means of correlation analysis of their MICs. Using piperacillin as a reference antibiotic the following order of succession could be arranged according to correlation coefficients in P. aeruginosa: cefoperazone, cefsulodin, lamoxactam, cefotaxime and N-f-thienamycin. For the Enterobacteriaceae species some antibiotics could not be evaluated in this test. Moreover, it was recognized that there was an obvious correlation between the activities of lamoxactam and cefotaxime in P. aeruginosa (r = 0.81) and E. coli (r = 0.80). A correlation was also observed between those of cefsulodin and cefoperazone in P. aeruginosa (r = 0.75). Lower correlation coefficients were seen in N-f-thienamycin with cefoperazone, piperacillin and cefsulodin in P. aeruginosa and with cefoperazone in Klebsiella spec.. Notwithstanding, strains resistant to cefsulodin and cefoperazone were inhibited by concentrations less than or equal to 8 micrograms/ml of N-f-thienamycin. These results showed that in N-f-thienamycin, cefotaxime and lamoxactam multiresistance has only a minimal influence on the MICs of the species of Enterobacteriaceae examined. For therapeutic considerations concerning multiresistance the small differences recognized among these three antibiotics might be without significance. However, N-f-thienamycin was distinctly more active in multiresistant strains of P. aeruginosa than the other beta-lactam antibiotics tested.

Anti-Bacterial Agents↗
PubMed1982

[Comparative in vitro activity of 5 semi-synthetic penicillins against aerobic Gram-negative bacilli and enterococci (author's transl)].

The MICs and MBCs of mezlocillin, ticarcillin and piperacillin were determined by microdilution in liquid medium against 700 strains of Gram-negative bacilli and enterococci isolated from pathological materials and classified according to their sensitivity of ampicillin and carbenicillin. Strains sensitive to ampicillin and carbenicillin were usually sensitive to the other penicillins with weight for weight differences in activity. The MIC pf mezlocillin against 40% of ampicillin - and carbenicillin-resistant TEM-producing strains of E. coli ranged fron 32 to 64 micrograms/ml. In 50% of Klebsiella strains producing a broad-spectrum penicillinase which inhibited ampicillin and carbenicillin, the MIC of mezlocillin was equal or inferior to 8 micrograms/ml. Carbenicillin-resistant Enterobacter and Citrobacter strains were also resistant to the other penicillins under study. Mezlocillin and piperacillin showed some activity on a few strains of carbenicillin-resistant Serratia, Proteus and Acinetobacter spp. Piperacillin and, to a lesser degree, mezlocillin were active against those strains of Pseudomonas spp for which the MIC of carbenicillin was around 512 micrograms/ml. Mezlocillin and ampicillin were the most active of the antibiotics tested against Enterococci. The MBCs of all antibiotics in this study were strongly influenced by the size of the inoculum.

Enterobacteriaceae↗
PubMed1980

[Susceptibility of Pseudomonas aeruginosa recently isolated from clinical specimens to various antimicrobial agents and changes of susceptibility to carbenicillin, gentamicin and amikacin (author's transl)].

We estimated the minimum inhibitory concentrations of following twenty-one antimicrobial agents against 161 strains of Pseudomonas aeruginosa isolated from clinical specimens during 1979. Antimicrobial agents were 5 penicillins (carbenicillin, sulbenicillin, piperacillin, apalcillin and ticarcillin), 3 cephalosporins (cefsulodin, cefoperazone and ceftizoxime), 5 aminoglycosides (gentamicin, tobramycin, dibekacin, amikacin and kanamycin), 3 tetracycclines (tetracyline, doxycycline and minocycline), chloramphenicol, colistin, polymyxin B, nalidixic acid and pipemidic acid. Among penicillins piperacillin and apalcillin showed strongest antibacterial activity and the activity of carbenicillin was weakest. Highly resistant strains against carbenicillin increased rapidly until 1975. Among cephalosporins cefsulodin showed strongest antibacterial activity and its activity was stronger than piperacillin. Antibacterial activity of cefoperazone and ceftizoxime were weaker than cefsulodin, but stronger than carbenicillin and sulbenicillin. Among aminoglycosides kanamycin showed very weak antibacterial activity, but another four drugs showed very strong activity. But resistant strains against these four drugs increased gradually and over 20% of strains was resistant to gentamicin. Among gentamicin, tobramycin and dibekacin cross-resistance was observed, but not between amikacin and these three drugs. Recently the number of strains resistant to both amikacin and gentamicin increased. Tetracyclines, chloramphenicol and nalidixic acid showed rather weak activity, but colistin and polymyxin B showed very strong activity and resistant strains against these drugs were very few. Pipemidic acid showed rather stronger activity than nalidixic acid, but its activity was weaker than aminoglycosides excluding kanamycin.

Amikacin↗
PubMed1982

[Activity of new beta-lactam antibiotics].

The antibacterial activity of the newer beta-lactam compounds mezlocillin, cefuroxime, cefotaxime, ceftizoxime, cefoperazone, lamoxactam, and cefsulodin was evaluated in 335 strains of ampicillin-resistant (MIC greater than 16 mg/l) enterobacteria, 50 pseudomonas aeruginosa, 28 acinetobacter species, and 50 streptococcus faecalis isolates. With the exception of some strains, enterobacteria were inhibited by low levels of cefotaxime and ceftizoxime, respectively. Between these both compounds there was an almost complete cross-resistance. In each species lamoxactam inhibited at least 90% of the isolates. The antibacterial activity of cefoperazone against enterobacteria was decreased; however, it was active against pseudomonas aeruginosa exhibited antibacterial activity comparable to that of azlocillin. Cefsulodin proved to be the most active drug against pseudomonas aeruginosa exceeding to some extent even piperacillin. Ceftizoxime was the most active drug against acinetobacter species. Among the new cephalosporins, it was only cefoperazone that exhibitediting antibacterial activity comparable to that of azlocillin. Cefsulodin proved to be the most active drug against pseudomonas aeruginosa exceeding to some extent even piperacillin. Ceftizoxime was the most active drug against acinetobacter species. Among the new cephalosporins, it was only cefoperazone that exhibitediting antibacterial activity comparable to that of azlocillin. Cefsulodin proved to be the most active drug against pseudomonas aeruginosa exceeding to some extent even piperacillin. Ceftizoxime was the most active drug against acinetobacter species. Among the new cephalosporins, it was only cefoperazone that exhibited some activity against streptococcus faecalis, which was comparable to that of cephalothin, but markedly impaired to that of cefazedone. With respect to streptococcus faecalis, the penicillin derivatives still remain the by far most active compounds.

Acinetobacter↗
PubMed1982

[Comparative bactericidal activity of beta-lactam-aminoglycoside combinations against Pseudomonas aeruginosa].

The effects of combining each of 10 beta-lactamins (carbenicillin, ticarcillin, piperacillin, azlocillin, cefotaxime, moxalactam, ceftriaxone, cefoperazone, ceftazidime, cefsulodin) with 6 aminoglycosides were studied in vitro against two strains of Pseudomonas aeruginosa. The bactericidal activity was tested by two methods: solid medium technique of "cellophane transfer" and "checkerboard" method (broth-dilution micromethod partly automatic). No single antagonism was observed. Concerning new penicillins, the percentage of synergy is increasing from carbenicillin, to ticarcillin, to azlocillin and finally to piperacillin. For recent cephalosporins, the most synergistic combinations are obtained with ceftriaxone, cefoperazone and ceftazidime. If aminoglycosides associations are considered, there is a good activity whichever antibiotic chosen, with a higher level for streptomycin and lower one for tobramycin. Dibekacin combinations, also tested by the checkerboard method, are particularly synergistic with azlocillin and piperacillin for new penicillins, and equally well with ceftriaxone for recent cephalosporins.

Aminoglycosides↗
PubMed1981

Overview of acylureidopenicillin pharmacokinetics.

The acylureidopenicillins which have been in man are azlocillin, mezlocillin, piperacillin, and furazlocillin (Bay k 4999). They exhibit dose dependent pharmacokinetics and accordingly upon increasing the doses have serum levels which are higher than the multiple of the dose, longer serum half-life (t1/2), and lower clearances (total serum clearance, renal clearance, and non-renal clearance). With doses of 1-2 g, t1/2 very between 0.7-1.1 h, and with 5.0 g 1.2-1.8 g. The elimination phase distribution volume corresponds to 10-30% of the body weight. The agents are excreted mainly through the kidneys. Referenced to the antibacterial activity of unchanged drugs, 50-80% of intravenous doses are eliminated in the urine. Only 25-35% of the dose of furazlocillin is excreted unchanged in the urine. The t1/2 is increased in reduced renal function, but mezlocillin is relatively little influenced by renal failure. With identical dose sizes, azlocillin appears to be subject to dose dependent pharmacokinetics to a higher degree than mezlocillin and piperacillin. Higher serum levels are also reached by azlocillin and the t1/2 of this agent is increased more in reduced renal failure than is the case for mezlocillin. The biliary levels of the acylureidopenicillins are high. A considerable biliary excretion occurs in reduced hepatic parenchymal function. The serum protein binding of these compounds decreases with higher concentrations varying between some 30% for 200 micrograms/ml and 50% for 2 micrograms/ml of azlocillin and mezlocillin, a mean of 16% for piperacillin in concentrations ranging from 20-300 micrograms/ml, and an average of 60% for furazlocillin. The acylureidopenicillins penetrate into tissues, cerebrospinal fluid and foetuses to produce therapeutic levels. The levels are rather low in bone tissue.

Absorption↗
PubMed1995

[In vitro activity of carbapenems (biapenem, imipenem and meropenem) and some other antibiotics against strict anaerobic bacteria].

During 1994, the in vitro antibiotic susceptibility of 306 anaerobic bacteria was performed in 4 hospitals, by the reference agar dilution method. Among the 129 B. fragilis group strains, only two B. fragilis strains were resistant to the three carbapenems and all beta-lactams, even combined with beta-lactamase-inhibitors while metronidazole resistance could not be detected. Evolution in antibiotic resistance rates could be assessed only for piperacillin whose resistance rates increased to 20%. beta-lactamase production was detected respectively for 27% of Prevotella and 17% of Fusobacterium strains. No beta-lactamase activity was seen among Gram positive anaerobes. On the whole anaerobic strains resistance rates were: biapenem, imipenem, meropenem and piperacillin-tazobactam 0.7, amoxicillin-clavulanic acid or metronidazole 2, piperacillin 11.3, amoxicillin 31%, respectively. The three carbapenems demonstrated a good in vitro activity against most anaerobes with few differences between them.

Bacteroides fragilis↗
PubMed1993

Perioperative antibiotic prophylaxis in patients undergoing radical surgery for gynecologic cancer: single dose versus multiple dose administration.

A prospective, randomized study comparing single dose intravenous antibiotic prophylaxis with multiple-dose regimen in patients undergoing radical surgery for gynecologic malignancy was carried out. The majority of patients had cervical cancer. Thirty-seven patients in group A received one dose of 4 g piperacillin and 800 mg tinidazole 30 minutes before surgery. Twenty-nine patients in group B additionally received 4g piperacillin 8 hours and 4g piperacillin and 800 mg tinidazole 16 hours after the first dose. There were no significant differences between groups A and B with regard to median patient age, performance status, cardiologic and pulmonary status, or frequency of diabetes. There were also no significant differences between either group with regard to the parameters documented postoperatively, such as median hospital stay, leukocyte values, or febrile episodes. Forty-three per cent of patients in group A and 48% of patients in group B had no complications (p > 0.05). Twenty-three per cent of patients in group A and 31% of patients in group B developed infections (p > 0.05), 85% of which occurred in the urinary tract. The data suggest that a single dose of intravenous antibiotics is as effective as multiple dose administration in the perioperative prophylaxis in radical gynecologic surgery.

Anti-Bacterial Agents↗
PubMed1993

The results of a targeted pharmacy intervention program.

Increasing resistance to ceftazidime and some other beta-lactam antibiotics developed among Enterobacter species after use of ceftazidime increased at a 500-bed community teaching hospital. Severe restrictions on the use of ceftazidime were imposed by pharmacy intervention. For empiric therapy of severe infections, a combination of tobramycin plus piperacillin was most frequently substituted for ceftazidime. Susceptibility patterns of Enterobacter returned to baseline within 3 months after active intervention reduced use of ceftazidime by 98% of its peak. There was no development of enhanced resistance to tobramycin or piperacillin or to other antibiotics on the formulary. It is concluded that active pharmacy intervention resulted in reversion of susceptibility of Enterobacter species to baseline for ceftazidime and the other beta-lactam antibiotics (ie, aztreonam, cefotaxime, ceftriaxone, mezlocillin, and piperacillin) for which covariance (ie, parallel decline of organisms' sensitivities) or cross-resistance had developed.

Anti-Bacterial Agents↗
PubMed1996

[Antibiotic sensitivity of aerobic gram-negative bacilli isolated from severe infections in 1992: results of a French multicenter study. Groupe d'Etude d'Infections à bacilles à Gram Négatif (GEIGN)].

OBJECTIVES: Antibiotic susceptibility of 649 gram-negative bacilli involved in severe infections and isolated in 18 teaching hospitals from January to December 1992 was evaluated. METHODS: Minimal Inhibitory Concentrations were determined by agar dilution method for piperacillin, piperacillin+ tazobactam and imipenem, and by a microdilution method for 11 other antibiotics (amoxicillin, amoxicillin + clavulanic acid, cefotaxime, ceftazidime, aztreonam, ticarcillin, ciprofloxacin, fosfomycin, tobramycin, gentamicin, amikacin). Criteria of Comité Français de l'Antibiogramme de la Société Française de Microbiologie were followed for interpretation. Betalactamases were identified by isoelectric focusing and overproduction of cephalosporinase was defined by the resistance phenotype. The main species isolated were Escherichia coli (45%), Pseudomonas aeruginosa (14%), Klebsiella pneumoniae (7.8%), Salmonella spp. (7.5%), Enterobacter cloacae (4%) and Klebsiella oxytoca (4%). Most of the strains were isolated from blood culture (72.3%), respiratory tract (11.4%) and intraabdominal infections (8.6%). Most of the enterobacteria isolates were susceptible to imipenem, aztreonam, amikacin and ciprofloxacin (percentages of susceptibility were respectively 99.3, 98, 98.3 and 96.3); in most of cases clavulanic acid did not entirely restore sensitivity to amoxicillin of penicillinase-producing strains. Among 89 P. aeruginosa strains, 82% were susceptible to imipenem and ceftazidime, 81% to the association piperacillin + tazobactam and 51% to ticarcillin. Resistance rates are very high for Acinetobacter baumannii except for imipenem. CONCLUSION: Production of TEM-type penicillinase and over-production of the chromosomal cephalosporinase are the most widely observed mechanisms of resistance (respectively 22% and 9% of 649 strains). Prevalence of extended spectrum betalactamases was low (1%) and essentially observed for K. pneumoniae.

Anti-Bacterial Agents↗
PubMed1997

[E-test to study small inhibitor concentrations, bacterial diversity and to identify presumptively beta-lactamases in strains of Pseudomonas aeruginosa and Acinetobacter baumannii associated with +nosocomial infections].

BACKGROUND: Pseudomonas aeruginosa and Acinetobacter baumanii are two important nosocomial agents that require permanent testing of their antimicrobial susceptibility. AIM: To use E-test to determine minimal inhibitory concentrations, estimate bacterial diversity and presumably identify B-lactamases of strains of Pseudomonas aeruginosa and Acinetobacter baumanii isolated from nosocomial infections. MATERIALS AND METHODS: Sixty eight strains of Pseudomonas aeruginosa and Acinetobacter baumanii isolated in a teaching hospital were analyzed with E-test strips to determine their minimal inhibitory concentrations for different antimicrobials. RESULTS: More than 75% of Acinetobacter baumanii were resistant to Piperacillin, Cefpirome, Cefepime, Gentamicin or Amikacin, 40% of strains were resistant to Ceftazidime, 27 and 53% of isolates had a decreased susceptibility to Meropenem and Piperacillin-tazobactam respectively. Twenty eight to 54% of Pseudomonas aeruginosa strains were resistant to Cefepime, Cefpirome, Ciprofloxacin and Gentamicin. Eighteen and 10% of strains were resistant to Meropenem and Imipenem respectively. Less than 10% of strains were resistant to Amikacin, Azireonam, Piperacillin-tazobactam or Ceftazidime. Most of beta-lactam resistance of Pseudomonas aeruginosa was associated to decreased susceptibility or resistance to Cefpirome, Cefepime or to Meropenem-Imipenem and did not match clearly with known beta-lactamase profiles. CONCLUSIONS: The knowledge of susceptibility of these bacteria responsible for nosocomial infections, will help to plan the appropriate use of antimicrobials.

Acinetobacter↗
PubMed1998

[In vitro activity of 10 antibiotics including pristinamycin and its two components (RP 12536 and 27404) against strict anaerobes].

The activities of the pristinamycin and its two components (RP 12536 and RP 27404) were investigated using the reference agar dilution method M11A3, on 175 anaerobic strains in comparison with that of erythromycin, clindamycin, metronidazole, amoxycillin either alone or combined with clavulanic acid, piperacillin, cefoxitin, cefotetan and cefotaxime. beta-lactamase production was detected for all the 55 B. fragilis group strains and 8/12 Prevotella and 2/18 Fusobacterium strains, respectively. On the whole anaerobes, resistance rates (%) were respectively: RP 27404 (69), RP 12536 (64), pristinamycin (5) erythromycin (31), clindamycin (17), metronidazole (7) amoxycillin (24), amoxycillin-clavulanic acid (2), piperacillin (7), cefoxitin (14), cefotetan (21) and cefotaxime (27). RP 27404 and 12536 had low activities on anaerobes but acted synergistically as pristinamycin. The greatest anti-anaerobic potencies were obtained with amoxycillin-clavulanic acid combination, pristinamycin, metronidazole and piperacillin. As resistance was not found for pristinamycin among Prevotella, Fusobacterium, Gram+ rods and Peptostreptococcus, this streptogramin may be an appropriate agent for the treatment of periodontitis, pulmonary, ENT, gynecologic and soft tissue infections where these anaerobes are frequently involved.

Anti-Bacterial Agents↗
PubMed1996

Enzyme-linked immunosorbent assay for detection of IgG against penicillins in children.

AIM: To establish an enzyme-linked immunosorbent assay (ELISA) for detection of IgG against penicillins and then investigate this antibody response in children. METHODS: Western blotting, ELISA, and hapten inhibition assay were used. RESULTS: Penicillins reacted with bovine serum albumin (BSA) to generate conjugate which was used as coating antigen (100 mg.L-1) in ELISA. A good correlation was found between absorbance (A) and dilutions of sample with a linear coefficient of 0.9918. Thirteen subjects who were clinically suspicious of penicillin allergy were tested for specific IgG by ELISA, 4 positive for benzylpenicillin, 1 for benzylpenicillin and piperacillin, and 3 for benzylpenicillin, piperacillin and ampicillin. CONCLUSION: An ELISA was successfully established and penicillin reactive IgG response in children was heterogeneous. IgG antibodies recognized benzylpenicillin molecule, degraded products and new antigenic determinant from conjugate. Cross reactions occurred among benzylpenicillin, ampicillin and piperacillin.

Child↗
PubMed1996

Benzylpenicillin induced specific non-IgE antibody response in mice.

AIM: To study whether or not the specific non-IgE antibody response in mice can be induced by benzylpenicillin in vivo. METHODS: Antibody response and antigenic cross reactions were determined by enzyme-linked immunosorbent assay (ELISA). Antigen molecules recognized by antibodies were tested by hapten inhibition assay. RESULTS: During d 1-d 50 after immunization, positive % of specific IgM, IgG, and IgA to benzylpenicillin were 100%, 50%-100%, and 17%-100%, respectively. IgM and IgG to benzylpenicillin also recognized ampicillin and piperacillin. The positive % of IgM and IgG to ampicillin were 23%-100% and 50%-100%, to piperacillin 43%-100% and 50%-100%, respectively. Aged benzylpenicillin showed an inhibitory effect on specific antibodies in a dose-dependent manner, and inhibitory % of specific IgM and IgG were 29%-87% and 29%-71%. However, freshly prepared benzylpenicillin had no effect. CONCLUSION: Specific non-IgE antibody response was successfully induced by benzylpenicillin in mice, in which the isotypes were mainly IgM and then IgG and IgA. Antibodies recognized degraded products, not benzylpenicillin molecule itself. Antigenic cross reactions occurred between benzylpenicillin, ampicillin, and piperacillin. Isotypes of antibodies responsible for cross reactions were mainly IgG and then IgM.

Animals↗
PubMed1998

Efficacy, safety, and tolerance of piperacillin/tazobactam compared to co-amoxiclav plus an aminoglycoside in the treatment of severe pneumonia.

An open, randomized, multicenter study was conducted to compare the efficacy and safety of piperacillin/tazobactam and co-amoxiclav plus aminoglycoside in the treatment of hospitalized patients with severe community-acquired or nosocomial pneumonia. Of the 89 patients who entered the study, 84 (94%) were clinically evaluable. A favorable clinical response was observed in 90% of the piperacillin/ tazobactam group and in 84% of the co-amoxiclav/aminoglycoside group (not significant). The bacteriological efficacy was comparable in both groups (96% vs. 92%; not significant). There was only one fatal outcome in the piperacillin/tazobactam group compared to six in the co-amoxiclav/aminoglycoside group regimen (P=0.058). The adverse event rate was non-significantly lower in the piperacillin/ tazobactam group compared to the co-amoxiclav/aminoglycoside group (2% vs. 7%; P=0.32). Piperacillin/tazobactam is safe and highly efficacious in the treatment of serious pneumonia in hospitalized patients. It compares favorably with the combination of co-amoxiclav/aminoglycoside.

Aged↗
PubMedDate not supplied

Tolerability of piperacillin/tazobactam in children and adolescents after high dose radio-/chemotherapy and autologous stem cell transplantation.

The combination of piperacillin with tazobactam (PIP/TAZ) extends the activity of piperacillin against gram-positive, gram-negative, and anaerobic bacteria. The broad-spectrum of this formulation, together with its low degree of organ toxicity observed in adults, makes PIP/TAZ a tempting choice for children with radio-/chemotherapy-induced neutropenia. However, the use of PIP/TAZ is not yet approved for children under 12 years of age. The tolerability of PIP/TAZ was assessed in 19 children and adolescents between 2 and 18 years of age who developed a fever during aplasia after high dose radio-/chemotherapy and autologous stem cell transplantation (HD-SCT) for primary multifocal or relapsed solid tumours. Treatment with PIP/TAZ was initiated on average 3 days after HD-SCT, and the treatment was continued for approximately 10 days. Both clinical observation and laboratory studies showed no relevant alterations that would have been attributable to PIP/TAZ treatment. These results indicate that PIP/TAZ appears to be well tolerated in children during the acute phase of HD-SCT.

Adolescent↗
PubMed2004

Double-disk synergy test positivity in Stenotrophomonas maltophilia clinical strains.

The double-disk synergy test (DDST) using Mueller-Hinton agar and antibiotic disks with centrally positioned disks of amoxicillin-clavulanate, ampicillin-sulbactam, and piperacillin-tazobactam and, at a center-to-center distance of 25-30 mm, 2-4 disks with 10 various beta-lactam antibiotics per one plate was performed in 58 clinical isolates of Stenotrophomonas maltophilia to determine the effectivity of 3 beta-lactamase inhibitors. When tested with clavulanate as the central beta-lactamase inhibitor synergic action on tested strains was the most frequent with aztreonam (81.0% of strains), cefoperazone (63.8%), and cefepime (60.3%). With sulbactam the synergic action, i.e. DDST positivity, was high in the case of cefoperazone (15.5%), ampicillin, aztreonam and piperacillin (8.6% each); with tazobactam it was the most frequent with aztreonam (53.4%), cefoperazone (44.8%) and cefepime (37.9%). No synergy was demonstrated after application of meropenem regardless of the kind of beta-lactamase inhibitor used. In 58 strains of S. maltophilia, 55 different profiles of DDST positivity were found. The results confirm that clavulanate is the most effective inhibitor of S. maltophilia beta-lactamases. The utilization of DDST (performed in the recommended way) for the typization of strains Stenotrophomonas species and for the estimation of potential effectiveness combinations of beta-lactams with beta-lactamase inhibitors for the therapy of stenotrophomonade infections was suggested.

Amoxicillin-Potassium Clavulanate Combination↗